Does Your New Health Plan Cover Abortion?

On Sunday, the Obama administration’s self-imposed deadline for fixing Healthcare.gov passed, with seemingly decent results. For the past month, the administration had been consumed with that task. But in the meantime another serious problem seems to have escaped its attention: Federal and state health-care exchanges make it nearly impossible to tell whether their plans cover elective abortion. And in some states customers don’t even have the option to purchase abortion-free coverage.

Last month, Secretary of Health and Human Services Kathleen Sebelius was brought before the House Energy and Commerce Committee to be questioned about the failures of Healthcare.gov. “If someone…has strongly held pro-life views, can you commit to us to make sure that the federal exchanges that offer that [abortion coverage] is clearly identified and so people can understand if they're going to buy a policy that has abortion coverage or not?” asked Rep. John Shimkus (R-Ill.). “I don’t know,” Sebelius answered. “I know exactly the issue you’re talking about. I will check and make sure that is clearly identifiable.”

That was November 1. It’s still nearly impossible to determine whether plans on the exchanges cover elective abortion. For example, on the New York State exchange—supposedly one of the best—the signup process is painless. You create a username and password, enter your legal name, address, Social Security number, and within moments you’re shopping for coverage. You can compare several plans at all levels of coverage (bronze, silver, gold, platinum). Monthly premiums are displayed first, followed by deductibles and out-of-pocket maximums. You can explore a plan’s outpatient-services coverage, its prescription-drug coverage, mental-health services, lab tests, etc. You can even see its pediatric-vision coverage. But you can’t find out whether a plan covers elective abortion.

New York is not alone. The Minnesota Department of Commerce—which regulates insurance—could not tell me how many of the plans on its exchange cover elective abortion. “If you have trouble locating the information through the public filings on SERFF, I would recommend calling the insurers directly,” a spokesperson told me. Same story in Vermont. And it’s no different on the federal exchange. A Healthcare.gov customer-support agent, who—after reminding me that federal dollars won’t pay for elective abortions—explained that the only way to know whether a plan included abortion coverage was to call the insurance companies directly. (Spokespeople for the HHS did not return requests for comment on this issue.)

The exchanges were designed to demystify the process of purchasing health insurance. The law’s complicated mechanisms for handling abortion funding—basically, customers seeking abortion coverage must write out a separate check for that part of the policy—are premised on the customer being able to tell whether the health plan they’re buying covers elective abortion. Unless the health exchanges make it clear which plans cover elective abortion and which don’t, then the ACA’s requirement that insurers segregate abortion funds makes little sense.

In order to remedy this situation, Rep. Chris Smith (R-N.J.) has introduced the Abortion Insurance Full Disclosure Act. The bill, which has the support of the U.S. Conference of Catholic Bishops, would amend the ACA to require all exchange plans to disclose whether they cover abortion, and to “prominently” display that information. It would also force insurers to show both payments a customer would have to make if she chooses elective-abortion coverage.

Transparency on the insurance market was one of the goals of Obamacare. If a customer doesn’t have to call the insurance company to find out whether her child’s eye exam is covered, then why should she have to when it comes to elective abortion? In this respect, the Abortion Insurance Full Disclosure Act ought to be a no-brainer.

Even if Rep. Smith were able to persuade enough House and Senate Democrats to sign on—only 2 of the bill’s 117 cosponsors are Democrats—that wouldn’t address another issue with the exchanges: In some states, all the plans cover elective abortion. As abortion took center stage in the 2009 health-care debate, it became clear that neither side would be completely satisfied with the final outcome. Many members of the prolife movement alleged that the bill allowed federal funding of abortions. Prochoicers thought the law stigmatized abortion. The law allows states to bar elective-abortion coverage from health-insurance exchanges. Twenty-three states have done so (to varying degrees). And in those that have not, the ACA forces insurers to jump through administrative hoops if they want to cover elective abortions. What’s more, the ACA mandates that every state offer at least one “multistate plan” (MSP) that does not cover elective abortions. The Office of Personnel Management (OPM), which runs the Federal Employee Health Benefits, has negotiated more than one hundred fifty of these plans. Only two of them, an OPM spokesman confirmed, cover elective abortion.

So if the Affordable Care Act requires at least one of these plans in every state to exclude elective abortion, then why do some exchanges fail to provide such an option? Because full implementation is delayed until 2017. In 2014, only 60 percent of states have to offer multistate plans—70 percent in 2015, 85 percent in 2016, and 100 percent thereafter.* This means that there are now nine states that have neither banned elective-abortion coverage from the exchanges nor implemented multistate plans: Connecticut, Hawaii, Iowa, Minnesota, New Jersey, Oregon, Rhode Island, Vermont, and Wyoming. Officials in Rhode Island and Connecticut confirmed that on their exchanges customers cannot buy plans without abortion coverage. A representative of Hawaii’s exchange said he thought all plans covered abortion, but couldn’t say for sure. Iowa, Oregon, and Wyoming do offer plans that don’t cover abortion, according to state officials. (Minnesota, New Jersey, and Vermont spokespeople did not tell me whether they offer plans without such coverage.)

Until the MSPs are fully implemented, thousands of Americans will contract for abortion coverage whether they like it or not—or wait until 2016 and pay the tax penalty for not having insurance until then.** Of course, until Obamacare came along, millions of Americans had no idea whether their insurance covered abortion—including members of the Republican National Committee.

The Affordable Care Act is one of the longest, most complex laws ever passed. That’s because it was written to make major changes to one of the largest, most complex markets the country has ever known. Of course it would run into trouble as its many features—and bugs—started to go live. Some of its problems are technically daunting, but others are not. Rep. Smith’s bill doesn’t stand a chance, but there are other ways for people to tell whether exchange plans cover elective abortion. Secretary Sebelius told Congress that she would “make sure” that such coverage would be “clearly identifiable” on the exchanges. Following through on that promise might help her win back some of the credibility she lost in the wake of the Healthcare.gov fiasco. She’d take heat from some prochoice activists, but when it comes to the health-care marketplace, how can you argue with greater transparency?

President Obama could use a credibility boost too. As Obamacare goes, so goes the Democratic Party in 2014. He may not be able to repair Healthcare.gov with a wave of his hand, but he could ask the OPM to target states without abortion-free coverage for MSP expansion next year. And he could certainly direct his administration to make sure abortion coverage is clearly disclosed in the exchanges. Before the president signed the ACA, he devoted a lot of energy to addressing the concerns of prolife Democrats. Without their votes, the Affordable Care Act might not have passed. Supporters of Obamacare owe them a debt of gratitude. So does Obama. It’s time for the president to settle that debt.

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* The original version of this sentence misstated the timing of the implementation of MSPs. They will be available in all fifty states by 2017, not 2016.

* * This sentence was corrected to reflect the fact that because the timing of MSP implementation is written into both the statute and the regulations, a regulatory remedy is insufficient.

Comments

Those who object to the self-financed abortion rider will know what their plan includes before they make the final separate payment required for the rider. Now, there may be the complaint that this comes after they have read through all of the plans and made a selection and then have to start all over. But the purpose of insurance companies not advertising the rider was because it would be a way of attracting the cheap to insure young non-child bearing women to these plans and leave the more expensive to insure parts of the population to the other plans, raising the costs of plans for people opposed to abortion. Now the pro-life movement has changed its mind and decided this is not a problem and wants the information up front. Let me know when they stop spinning around.

I'm not sure that this can be fixed in the regulations, since the law passed by Congress requires witholding the information until the moment of enrollment. Section 1303 says (bracketed text added by me)

SEC. 1303...3) RULES RELATING TO NOTICE

(A) NOTICE.—A qualified health plan that provides for coverage of the services described in paragraph (1)(B)(i) [abortions other than in the case of rape, incest or danger to the life of the mother] shall provide a notice to enrollees, only as part of the summary of benefits and coverage explanation, at the time of enrollment, of such coverage.

(B) RULES RELATING TO PAYMENTS.—The notice described in subparagraph (A), any advertising used by the issuer with respect to the plan, any information provided by the Exchange, and any other information specified by the Secretary shall provide information only with respect to the total amount of the combined payments for services described in paragraph (1)(B)(i) and other services covered by the plan.

I am confused. If the abortion rider is optional and requires a separate payment from the insurered, how does this increase the cost of plans for those who want it?

Clearly, those young, non-marrired people who don't want abortion coverage, or those young married people who also don't want it, have the option to decline the coverage. All other people who want abortion coverage will pay the cost of it. As someone who understands and is experienced in actuarial science, most insurance company acturaies will set rates assuming convervative assumptions about what classes of the population will elect abortion coverage, thus setting rates that will be self-sufficient.

In my opinion, young non-married people will not elect abortion coverage and most other people will choose or reject it based on the surveys of the population that are pro-life or pro-choice.

You appear to agree with the USCCB's interpretation of that portion of the statute. I find that reading unpersuasive. The language is sloppy, and possibly intended to prevent insurers from advertising their abortion coverage, but there's no reason it could not be interpretted to mean that enrollment begins when a person starts shopping for insurance.

I have to confess that in my 27 years of seeking my own health care coverage, I have never asked this question. I guess my default view has been that, in this instance, the sin lies with those who seek, practice and provide abortion. And, that I was not an accessory to murder or somehow "funding abortion" because I participated in my employer's health care plan. I don't mind that people want to opt out of plans that provide for abortion, to make a statement about the issue. But I worry about where this could go. Will I someday be required, as a practicing Catholic, to opt out of such plans? How scrupulous will I have to be about this issue? Do those who would rashly consider such a thing also consider being scrupulous about all the other things our government does, like torture and capital punishment, that the Catholic Church teaches against? I understand that we must speak out against serious wrongs. The cost of not speaking out is very high. But how you go about it matters too.

Is Tim Jost preparing an analysis of it? It would be a time consuming job

Your thought of interpreting "enrollment" as the whole shopping experience might be a way in which regulations could force the "abortion", "no abortion" identification early on in the shopping process rather than letting insurors hold off until the last minute. It would be interesting to hear Tim's thoughts on that.

Grant, DC Health Link says this in their FAQ, so it appears that they don't believe that the regulations prohibit making this information available up front. Perhaps HHS needs to tell other exchanges to "Go and do likewise"

Which health plans offered through DC Health Link include coverage for elective abortions and which plans do not?

Answer

Health plans that do not provide coverage for elective abortions include all Aetna health plans, as well as the multi-state plans (MSP) offered by CareFirst BlueCross BlueShield (only the plans that include “Multi-State Plan” in their name). All health plans offered by Kaiser Permanente, United Healthcare, and CareFirst BlueCross BlueShield plans that do not include “Multi-State Plan” in their name include coverage for elective abortions.

Wouldn't it be useful for the bishops' conference in each state to put some people to work on researching, writing, and publicizing a similar FAQ for the plans available in their state? It doesn't seem that it would be an enormous job.

it would be good if the FAQ could go on to explain what choices those bishops consider legitimate in cases like these:

1. There is no plan available this year that does not cover abortion

2. Your long-time doctor is only available through a plan that covers abortion

3. All "no abortion" plan(s) are more expensive or provide poorer benefits than an "abortion" plan.

I suppose some state bishops conferences might say that you can't buy any plan that covers abortion, while others might say it is a prudential decision

Grant, I agree with your point about the importance of transparency and the Administration's responsibility to live up to its promises. Having thought about your original post in light of other news stories and the fact a number of states (Michigan the latest) now require "rape riders," I'm wondering about larger issues of transparency. Will the average woman signing up know to ask about coverage for emergency contraception when she goes to the ER after an assault? More important to me: does the value of transparency extend to Catholic hospitals being required to publicly inform their communities what care they will NOT provide in the case of miscarriages, sexual assaults, life of mother at risk, etc?

Why do people worry about abortion coverage? Having a policy does not compel anyone to use any such part of the policy. For those of us beyond child bearing ages it's academic at worst. For those still with the risk/joy of becoming pregnant, it's an option. Having the option does not compel using it.

If it's a matter of cost, then consider: if 300,000,000 Americans are covered for abortion, with roughly half now or earlier or later susceptible of becoming pregnant, then intelligent insurers can figure out what the statistical probability of any one such person both becoming pregnant and choosing abortion, by which time the precentage of the premium attiributable to abortion is minuscule.

And by the way, consider those awful, contraception and abortion facilitating, horrible, immoral sources of such risks known as .... paychecks.

The company that has a de facto monopoly on self-insurance in my state does cover abortions. I only thought to ask when I enrolled in 2009 because the Stupak Amendment was in the news at the time. Maybe the great martyrs of the past would have gone without coverage, but I didn't see how I could, so I enrolled anyway.

I am actually more to the right economically than most posters here, but the emphasis by the bishops and Catholic intellectuals on government-run plans that cover abortions and complete lack of attention toward business-run plans that do so bothers me.

As the chief health insurance regulator in RI when the insurance excange was set up and a practicing Catholic the abortion issue was positively bedeviling. As a matter of policy, we wanted to get the insurance exchange up and functioning quickly and effectively, to get people affordable health insurance coverage. A minority of people considered the existence of abortion coverage to be a determining factor in their decision making process about purchasing coverage (this includes pro's and con's - the vast majority are oblivious for what is a very small portion of the insurtance premium). A smaller minority (some with considerable political influence) were determined to use abortion coverage as a wedge issue to bring down the exchange. The negotiated settlement to make sure federal funds are not used to pay for abortions is virtually unadministrable. In the end, the decsion about whether or not to offer abortion coverage as a benefit was left to the plans. (all did), We did not require them to offer a plan without it - it would have doubled the number of plans on the exchange "on the shelf". ,(In the large group market, you can have it excluded as a benefit if you want - there is no discount; in the small group and individual market we never revived one complaint - nbody cared in very Catholic RI)

On the issue of disclosure. The exchanges are facing a herculean task - in the earlier periods, sending people to insurers for additional information does not strike me as unreasonable.

As to the morality of one's premiums financing something one finds morally objectionable (even if I choose not to use it myself) , my premiums are also paying for a lot wasted medical care and inappropriate services (infertility services for women over 40?) that limit access for lower income folks. They are also paying for contraceptive service (pace Madame Secretary) My tax dollars are financing activities I find morally objectionable but are the law of the land. A more effective way to address the financing question is to make the activity itself illegal or not collectively financed (efforts to exclude abortion from insurance coverage have been tosssed out by the courts) - expecting extensive personal accomodation when one objects to what is legal and permissible seems to ignore the responsibility of citizens to live by the laws of the land while they work to change them.